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* 1. What grade are you currently in?

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* 2. During this school year, have you or will you participate in an afterschool activity such as sports, clubs, cheerleading, etc.?

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* 3. Do you think the school offers enough after-school activities?

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* 4. Since the beginning of the school year, has either of your parents or guardians attended a school meeting?

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* 5. Since the beginning of the school year, has either of your parents or guardians spoken to any of your teachers, counselors, or administrators?

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* 6. Since the beginning of the school year, has either of your parents or guardians had a meeting with any of your teachers, counselors, or administrators?

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* 7. Since the beginning of the school year, has either of your parents or guardians visited any of your classes?

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* 8. Since the beginning of the school year, has either of your parents or guardians attended a school event where you participated?

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* 9. I am a good student (“B” average or better)

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* 10. I do very well on schoolwork (A’s and B’s on most assignments)

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* 11. I am good at Math

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* 12. I am good at Reading and Writing

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* 13. I do well on most tests in school (A’s and B’s on most tests)

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* 14. I am as good of a student as I would like to be

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* 15. I am happy with myself as a person

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* 16. I am the kind of person I want to be

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* 17. I think if I tried harder I could do better in school

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* 18. I give up when my schoolwork is hard to do

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* 19. For the following questions, please choose how severe each item is in your building.

  Serious Problem Somewhat of a problem A minor problem Not a problem at all
How much is student tardiness a problem in your school?
How much is cutting class a problem in your school?
How much is physical conflicts among students (fights) a problem in your school?
How much is robbery of theft a problem in your school?
How much is vandalism of school property a problem in your school?
How much is student use of alcohol a problem in your school?
How much is student use of illegal drugs a problem in your school?
How much is student possession of weapons a problem in your school?
How much is verbal abuse of teachers a problem in your school?

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* 20. Adults (teachers, counselors, administrators) at my school back me up when I need them.

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* 21. I can count on adults (teachers, counselors, administrators) at my school for emotional support.

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* 22. Adults (teachers, counselors, administrators) at my school and I find it easy to talk to each other

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* 23. Adults (teachers, counselors, administrators) at my school notice and give me help when I need them to.

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* 24. Do you have a specific place in your home where you can do your homework without being distracted or interrupted?

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* 25. Do you have a computer at your home that you can use to access the internet and complete homework assignments?

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* 26. During a typical week, how often do you discuss school activities or events with your parents or guardians?

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* 27. During a typical week, how often do you discuss things that you have studied in class with your parents or guardian?

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* 28. During a typical week, how much time do you spend on homework?

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